Intermittent Exotropia: Evaluation and Therapy

Knapp, Philip Coombs

doi:10.1080/0065955x.1953.11981081

Cited by 28 publications

(15 citation statements)

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“…Baker and Davies 20 demonstrated that patients who underwent surgery after the age of 4 showed better functional results. On the other hand, Knapp 21 and Pratt-Johnson et al 5 advocates early surgery for treatment of intermittent exotropia.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia

Lim

Hwang

Kim

2012

Eye

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Purpose The purpose of this study is to evaluate prognostic factors, specifically age, at the time of surgery, for recurrence after bilateral lateral rectus recession (BLR) in patients with intermittent exotropia. Methods Medical records of 511 subjects who underwent BLR procedures between the ages of 3 and 10 years with more than 12 months of follow-up were retrospectively reviewed. Patients' surgical outcomes with a deviation of less than 10 prism diopters (PD) exotropia and less than 5 PD esotropia were defined as a success. Outcomes with more than 11 PD exotropia were designated as recurrences, and those with esotropia of more than 5 PD after 3 months of surgery were noted as overcorrection. Prognostic factors for recurrence were analyzed by multivariate logistic regression test. Results Of the 511 subjects, 371 had successful surgical outcomes and 129 had recurrences, whereas 11 were found to be overcorrected. Age at surgery and immediate postoperative alignment proved to be significant factors influencing a favorable outcome by multivariate logistic regression analysis (Po0.05). However, gender, photophobia, age at onset, spherical equivalent (SE) refractive error, astigmatism, SE anisometropia, and preoperative deviation size were not significantly predictive of success (P40.05). Conclusion In BLR procedures, increasing patient age at surgery was associated with lower recurrence rates.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia

Lim

Hwang

Kim

2012

Eye

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“…In regard to the changes in angle of deviation seen in patients with exotropia, Knapp [2] reported that fundamental exodeviation is present at birth, and the observed deviation increases as dynamic factors, such as accommodative convergence, change. Jampolsky [16] and von Noorden [7] reported that exophoria and X(T) have a common basis and usually arise in infancy, but that the latter may progress throughout life, both in degree and frequency of deviation.…”

Section: Discussionmentioning

confidence: 99%

“…Intermittent exotropia manifests various clinical symptoms and mostly occurs at 2 to 4 years of age. It is known that, as children grow, the incidence of exodeviation increases or is maintained [2,3]. With regard to the changes in the angle of deviation associated with exotropia, Burian and Spivey [4] reported that exuberant convergence in childhood can mask an exotropia and that convergence weakens with age, producing an increasingly divergent position of the eye.…”

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confidence: 99%

A Comparison of the Clinical Characteristics of Intermittent Exotropia in Children and Adults

Jung

Lee

2010

Korean J Ophthalmol

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PurposeThe purpose of this study was to compare and differentiate the clinical characteristics of intermittent exotropia (X(T)) in children and adults.MethodsThis study included 398 patients with X(T): 360 children ranging in age from 1 to 14 years and 38 adults over 15 years of age. Patients with neurological abnormalities or developmental delays were excluded. Clinical characteristics of interest included sex, age on first visit, age of onset, type of onset, duration to surgery, family history, chief complaints, type of fixation, refractive errors, sensory tests, angle of deviation, fundus examination, oblique muscle dysfunction, and other associated ocular disorders.ResultsIn both groups, an insidious onset was more common than a sudden onset (p=0.033). Outward deviation was the most common chief complaint in both groups, followed by photophobia in the childhood group, and diplopia in the adult group. The most common subtype of X(T) was the basic type. The mean near deviation was 23.6±7.9 prism diopters (PD) in the childhood group and 30.7±12.2 PD in the adult group (p=0.01). The mean distance deviation was 23.4±6.1 PD and 28.3±11.2 PD in the childhood and adult groups, respectively (p=0.028). The rate of fusion, measured with the Worth 4-dot test at near and distance was higher in the childhood group, as compared to the adult group (p=0.024 and p=0.048, respectively).ConclusionsAmong X(T) patients, the chief complaints, angle of deviation, and Worth 4-dot tests showed significant differences between the childhood and adult groups. Therefore, these are important factors to consider when assessing adults and children with X(T).

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“…3,4 According to Knapp, the angle of deviation seen in patients with exotropia is basically present at birth as exodeviation, and the obvious deviation increases as dynamic factors like accommodative convergence change. 5 It has been suggested that exophoria and X(T) usually arise in infancy and become obvious over time, not only in degree but also in the frequency of deviation. 6,7 There is still no broad consensus on surgical interventions for intermittent exotropia as the best treatment options.…”

Section: Long-term Results Of Surgery For Intermittent Exotropiamentioning

confidence: 99%

“…As children grow, the incidence of exodeviation increases or is maintained. 5,11 With regard to the changes in the angle of deviation associated with exotropia, Burian and Spivey reported that exuberant convergence in childhood could mask an exotropia and that convergence weakened with age, producing an increasingly divergent position of the eye. 12 The outcome of strabismus surgery shows great variability among patients.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of Surgery for Intermittent Exotropia

Keskinbora¹,

Horozoğlu²,

Gönen³

et al. 2012

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To evaluate the long-term surgical outcomes in a population with intermittent exotropia X(T) who were operated by the same surgeon. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The medical records from January 1991 to December 2008 were retrospectively reviewed. Patients were examined on postoperative day 1, in week 1 and week 6, at 6 months and 1 year, and then every year. Twenty four of 43 patients underwent bilateral lateral rectus recession and 19 patients underwent unilateral recession-resection for X(T). R Re es su ul lt ts s: : Forty-three patients underwent surgery at a mean age of 11.2±4.6 years (range, 6 to 25 years). Eleven of the 43 children (25.6%) underwent a second surgical intervention (9 for recurrent exotropia and 2 for consecutive esotropia), and no patient received more than 2 interventions. Four patients were lost to follow-up after 2 years. Mean follow-up time was 9±5.2 years for 39 patients. Consecutive esotropia (ET) developed in 9 (21%) patients with immediate overcorrection of at least 20 prism diopters (PD). Only two cases of consecutive ET required second surgery. Postoperative esodeviation developed in almost all cases and it showed a tendency to progress to exodeviation with longer follow-up time. Nine cases required surgery for residual or recurrent exotropia. Finally, 28 of the 39 (71.8 %) were within 10 PD of orthotropia at distance and 18 of 39 (46.2%) had a stereopsis better than 60 seconds of arc. C Co on nc cl lu u--s si io on n: : In this population with intermittent exotropia, although 11 cases underwent a second surgical intervention, after a mean follow-up of 9.8 years, approximately 3 out of 4 cases were successfully aligned and 46.2% had high-grade stereopsis.K Ke ey y W Wo or rd ds s: : Exotropia; surgery; strabismus Ö ÖZ ZE ET T A Am ma aç ç: : Aynı cerrah tarafından ameliyat edilen intermitan ekzotropyalı [X(T)] hastaların uzun vadeli sonuçlarını değerlendirmek. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Ocak 1991 ile Aralık 2008 arasındaki tıbbi kayıtlar, geriye dönük olarak gözden geçirildi. Ameliyat sonrası değerlendirmeler sırasıyla ilk gün, 1 hafta, 6 hafta, 6 ay, 1 yıl sonra ve 1. yılın ardından her yıl yapıldı. Kırk üç hastanın 24'üne [X(T)] için iki taraflı lateral rektus geriletme ameliyatı ve 19 hastaya tek taraflı geriletme-kısaltma ameliyatı yapıldı. B Bu ul lg gu ul la ar r: : Kırk üç hasta ortalama 11,2±4,6 yaşında (6-25 yaş) ameliyat edildi. Kırk üç çocuğun 11'ine (%25,6) ikinci bir ameliyat yapıldı (Dokuzu rekürren ekzotropya için, ikisi ardıl ezotropya için). Hiçbir hastaya 2'den fazla ameliyat yapılmadı. Dört hasta ikinci yıldan sonra takip edilemedi. Otuz dokuz hastada ortalama takip süresi 9,8±4,9 yıldı. Ameliyattan hemen sonraki günlerde dokuz (%21) hastada aşırı miktarda [en az 20 prizma dioptrisi (PD)] ardıl ezotropya (ET) gelişti. Altı ay takipten sonra, ardıl ET gelişen hastalardan sadece ikisine ikinci bir ameliyat gerekti. Olguların hemen hepsinde postoperatif...

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Intermittent Exotropia: Evaluation and Therapy

Cited by 28 publications

References 9 publications

Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia

Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia

A Comparison of the Clinical Characteristics of Intermittent Exotropia in Children and Adults

Long-Term Results of Surgery for Intermittent Exotropia

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